My Mother is 94 and has dementia but she still lives alone in her home. She has carers visiting 3xs a day. The care company started to use a digital system 6 weeks ago and the carers input all her normal records into their mobiles so now no records are kept at her home. No healthcare worker can now see her notes, can’t check if her medications have been given, if she has eaten breakfast, when she went to the toilet etc etc and Mum doesn’t remember if she is asked. Only yesterday I arrived and found Mum very wobbly and very sleepy, she couldn’t keep her eyes open. With no records I didn’t know if she woke up like it or if her meds had been given. I checked the dosset box and her thyroid med was still in the box. I presumed that the carer hadn’t made a mistake with the days and gave it to Mum. Within an hour she had recovered well. I was put into this position, what if a dr had visited and thought of a UTI! The care company wants to charge Mum for accessing her records of £10 month. My brother who is POA is refusing to pay and is insisting on having her records. The care company have now given us 4 weeks notice and says Mum’s records will then be given to us. The social services part pay for Mum’s care and she pays the rest. The care company is saying its GDPR, is this true? Are all care records now going digital? It seems ridiculous. Mum has two fantastic carers and she calls them darling. We don’t want to lose them. This is the third care company we have had after bad carers making dangerous mistakes. My brother set up cameras and they are so useful, I don’t worry so much about Mum. Also the company have taken away the carers travelling time so they always arrive 10 mins late and go early now. We spoke to the care company about it and they said it has always been like that but speaking to the carers it is a new timetable and they have to rush around. Any information would be appreciated
Hi Lou.
Care agency record keeping ?
Look no further … a legal view :
https://app.croneri.co.uk/feature-articles/record-keeping-legal-requirements?product=134
An extract :
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Care Quality Commission requirements
The legal requirements for the keeping of records are set out in Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) 2010. The first part of the Regulation explains why records are needed — providers who do not have relevant information will jeopardise the health, well-being and safety of their service users, who then will not benefit from the services provided.
The requirements to keep certain kinds of records are broken down into two sections.
In Regulation 20 (1a), care providers must keep accurate records and relevant documentation about the person needing the service (ie care records).
In Regulation 20 (1b), care providers must keep corresponding records about the people employed to provide the service (ie staffing records) and the management of the service. The Regulation does not spell out what records are required for management purposes. However, it is clear that some records are always required as a result of other legislation and regulations, which apply to all business organisations (eg health and safety records). Other record keeping requirements are built into other parts of the compliance framework (eg for policies and procedures).
Having set out the requirements for the keeping of certain records, Regulation 20 turns attention to how the records must be kept.
In 20 (2), it requires any record, paper or electronic, to be kept securely, but in a place where it can be accessed promptly when needed. A record should then be kept for an “appropriate” period of time, after which it should be securely destroyed.
Taken as a whole, the Regulation lays the basis for a record keeping system that, to be legally compliant, requires care providers to pay attention to all relevant aspects, as stated in Regulation 20 and the accompanying guidance found in Outcome 21: Records of the Care Quality Commission’s Guidance about Compliance: Essential Standards of Quality and Safety.
Common requirements
The guidance found in Prompt 21A applies to all regulated services. Broken down, Prompt 21A makes the following requirements.
Care records
Care services must be able to show that:
they keep a record of the care and treatment being provided to each service user
the records are used to plan and describe the care and treatment for the individual in line with his or her needs
they keep that record up to date
the recording is carried out promptly, and is accurate and factual
the recording keeps in mind the person’s needs for dignity and confidentiality, ie it should never be abusive, judgmental or libellous
the records link together, in a confidential manner, information about the person that relates to his or her past, or to his or her care and treatment from other professionals and agencies
they record all messages about service users’ care and treatment, including those made by word of mouth, eg telephone calls.
I agree with this post entirely. I can’t see my son’s notes now they are stored electronically. As I am also a carer for him, when he comes home, there are things I need to know. I’m going to raise this issue at the next meeting.
I believe our care company is about to do this as well which is really frustrating as I read the record book when I get home to see what’s happened during the time I’m away at work.
The records are so valuable to keep an eye in case a pattern develops of my mum going off her food, and as she suffers from Crohn’s disease if I need to increase her medication etc
The care company haven’t said if I will be able to access the records online but they should be made available
A frequent topic on the Alzheimers Society forum :
Update…I spoke to the CCQ regarding this and they said we could make a complaint, but I didn’t, just knowing that helped me stand my ground. After speaking to the social services care worker and being ‘nice’ to the owner, she said she would think about it and gave me a deadline. A few minutes before midnight she sent an email saying that because she cared for my Mum she would continue care this once. The social worker has not got back to us. It appears that she had been telling lies, the mobile app was not working correctly even though she said other people were using it. In fact I am the first to be using it now, months after she stopped the paper records. Anyway, I am getting it for free now. The carers are very happy. All this stress and she was lying all the time trying to get £120 out of us. My Mum was 95 a few days ago and had a lovely day and the carers shared in the festivities.